Intercostal space

The intercostal space (ICS) is the anatomic space between two ribs (Lat. costa). Since there are 12 ribs on each side, there are 11 intercostal spaces, each numbered for the rib superior to it.[1]

Intercostal space
Intercostal spaces, viewed from the left.
Sternocostal and interchondral articulations. Anterior view.
Details
Identifiers
Latinspatium intercostale
TA98A02.3.04.007
TA21102
FMA12243
Anatomical terminology

Structures in intercostal space

Order of components

Muscles

There are 3 muscular layers in each intercostal space, consisting of the external intercostal muscle, the internal intercostal muscle, and the thinner innermost intercostal muscle.[2][3] These muscles help to move the ribs during breathing.[4]

Neurovascular bundles

Neurovascular bundles are located between the internal intercostal muscle and the innermost intercostal muscle.[3] The neurovascular bundle has a strict order of vein-artery-nerve (VAN), from top to bottom.[2] This neurovascular bundle runs high in the intercostal space, and the smaller collateral neurovascular bundle runs just superior to the lower rib of the space (in the order NAV from superior to inferior). Invasive procedures such as thoracentesis are performed with oblique entry of the instrument, directly above the upper margin of the relevant rib, to avoid damaging the neurovascular bundles.[2]

Nerves

In reference to the muscles of the thoracic wall, the intercostal nerves and vessels run just behind the internal intercostal muscles: therefore, they are generally covered on the inside by the parietal pleura, except when they are covered by the innermost intercostal muscles, innermost intercostal membrane, subcostal muscles or the transversus thoracis muscle.

References
  1. Troyer, A. D., Kelly, S., Macklem, P. T., & Zin, W. A. (1985). Mechanics of intercostal space and actions of external and internal intercostal muscles. Journal of Clinical Investigation, 75(3), 850-857. doi:10.1172/jci111782
  2. Jacob, S. (January 1, 2008), Jacob, S. (ed.), "Chapter 3 - Thorax", Human Anatomy, Churchill Livingstone, pp. 51–70, doi:10.1016/b978-0-443-10373-5.50006-3, ISBN 978-0-443-10373-5, retrieved November 16, 2020
  3. Rakovich, George; Fréchette, Éric; Deslauriers, Jean (January 1, 2010), Lewis, Michael I.; McKenna, Robert J.; Falk, Jeremy A.; Chaux, George E. (eds.), "8 - Thoracic Surgical Anatomy and Procedures", Medical Management of the Thoracic Surgery Patient, Philadelphia: W.B. Saunders, pp. 95–105, doi:10.1016/b978-1-4160-3993-8.00008-8, ISBN 978-1-4160-3993-8, retrieved November 16, 2020
  4. Watkins, James; Mathieson, Ian (January 1, 2009), Watkins, James; Mathieson, Ian (eds.), "CHAPTER 3 - The skeleton", The Pocket Podiatry Guide: Functional Anatomy, Edinburgh: Churchill Livingstone, pp. 67–105, doi:10.1016/b978-0-7020-3032-1.00003-2, ISBN 978-0-7020-3032-1, retrieved November 16, 2020
  • Anatomy figure: 18:04-00 at Human Anatomy Online, SUNY Downstate Medical Center - "Structural organization within an intercostal space."
  • Anatomy photo:18:01-0108 at the SUNY Downstate Medical Center - "Thoracic Wall: The Anterior Thoracic Wall"
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